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Clinical Nursing Judgment

Trey Walden

Youngstown State University


“Nursing is a practice based discipline and one of the basic objectives of nursing

education is to achieve clinical judgment. (1) Clinical judgment is essential for decision-making

(2) and is considered an inseparable part of a high quality nursing care (3)” (Pouralizadeh,

Khankeh, Ebadi, Dalvandi, 2017). This article talks about what clinical judgment is, as well as

what factors influence us as students in becoming competent in our own clinical judgment skills.

This is important because as nursing students we need to be able to use our critical thinking skills

so that we are able to use safe and effective nursing clinical judgment. If we do not have good

clinical judgment skills in the nursing field then we could possibly put our patients at risk for

harm or injuries (Pouralizadeh, Khankeh, Ebadi, Dalvandi, 2017). Through research it has been

found that many new nursing students do not possess as much clinical judgment skills as

expected upon graduation (Pouralizadeh, Khankeh, Ebadi, Dalvandi, 2017). Therefore, it is

important to develop critical thinking skills and experience in nursing school so that we are able

to rely on our own clinical nursing judgment skills as individual nurses.

In the same article, they explain, “Since clinical judgment is an interactive phenomenon

and dependent on context and culture, it can be affected by many different factors. According to

Tanner’s clinical judgment model, cultural and social factors and clinical environment affect

nurses’ clinical judgment” (Pouralizadeh, Khankeh, Ebadi, Dalvandi, 2017). What they are

trying to say is that clinical judgment is dependent on many different factors, and that there is no

correct answer when making a judgment. Some factors that can influence nursing clinical

judgment are the patients cultural background, current health status, financial situation, and

home environment. These all play a role in the nurse’s ability to make a correct clinical judgment

so that they are able to effectively care for their patient.


In order to maintain good nursing clinical judgment, the nurse must be an advocate for

their patient. One way a nurse can be an advocate is speaking up when they are concerned for the

safety or well-being of their patient (S. Shannon, 2017). Nurses’ are the ones who are always at

the patients’ bedside and are constantly monitoring and assessing them (S. Shannon, 2017). In

the same article, they go on to say; “Nurses care for the patients after they have received

respiratory care or treatments by physical therapists, after they have received new medications,

and during their recovery from injury or illness. As a result, a nurse is often the member of a

health care team most likely to notice changes that might signal problems or poor responses to

treatment (S. Shannon, 2017). What this article is saying is that because the nurse is always at the

patients’ bedside, it is their duty to use their nursing clinical judgment skills to be an advocate for

their patients’ and speak up when they think something might be going on with their patient and

communicate it to the healthcare team.

Another important skill that a nurse needs to have to maintain good nursing clinical

judgment is the ability to critically think. In nursing there is no clear-cut answer to every

situation that you are going to face in the hospital. In the article, Think Like a Nurse: A Critical

Thinking Initiative, Terry Ward and Tiffany Morris state, “Thinking like a nurse or nurse’s

clinical judgment is an interpretation or conclusion about a patient’s needs, concerns, or health

problems and/or the decision to take action use or modify standard approaches, or improvise new

ones as deemed appropriate by the patient’s response” (2016). This is saying that critical

thinking involves taking multiple factors from a patient and linking them together to come up

with a solution or plan of action for what needs to be done. Critical thinking can be linked back

to being the patient’s advocate. An example would be a nurse notices that a patient is scheduled

for a magnetic resonance imaging later that day but remembers reading in the patient’s chart that

they had a pacemaker. The nurse therefore messages the doctor to inform them about the

pacemaker because the patient might not be compatible with the MRI. In this example, the nurse

used critical thinking by remembering the patient had a pacemaker and then advocated for their

patient by messaging the doctor to see if it was compatible with the MRI.

The example I am using for nursing clinical judgment is from this semester during my

nursing transitions. I was on the MICU with a patient who was having a gastrointestinal bleed.

The patient was on multiple vasopressors such as vasopressin, levophed, and neosynephrine.

Along with the multiple vasopressors, the patient had been receiving PRBC’s, FFP and platelets.

We had been adjusting the vasopressors all morning trying to stabilize the patient’s blood

pressure because it was staying in the low range no matter how much vasopressors we gave

them. My preceptor and I used our critical thinking skills by taking a look at the patient’s chart

and examining the lab values, where we noticed that the blood calcium level was low. We then

came to the conclusion that the patient’s blood pressure may not be rising because of the low

blood calcium level. When giving multiple blood products this can sometimes cause the blood

calcium levels to decrease which will in turn effect the blood pressure. After we came to the

conclusion that it may be the blood calcium level effecting the patient’s blood pressure, we used

our clinical nursing judgment skills by sending the doctor a message saying that the patient’s

blood pressure may be staying in the lower ranges due to all of the products being given,

therefore causing the blood calcium levels to decrease. After we sent the message, we received

an order twenty minutes later for calcium gluconate so that we could treat the low blood calcium

levels and hopefully help the blood pressure increase to a more stable pressure. The calcium

gluconate helped the blood pressure stabilize and we were able to wean down on some of the

vasopressors once the blood pressure started to stabilize and react to the vasopressors.



Influencing Nursing Students' Clinical Judgment: A Qualitative Directed Content

Analysis in an Iranian Context. Journal Of Clinical & Diagnostic Research, 11(5), 1-4.


Shannon, S. E. (2016). The Nurse as the Patient's Advocate: A Contrarian View. Hastings Center

Report, 46S43- S47. doi:10.1002/hast.632

Ward, T. D. (2016). Think Like a Nurse: A Critical Thinking Initiative. ABNF Journal, 27(3),


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